Cerebellar Hemangioblastoma Management in Pregnancy: A Case Report [20H

Abstract

INTRODUCTION: We present a rare case of sporadic cerebellar hemangioblastoma diagnosed in pregnancy. METHODS: A 37-year-old gravida 3 para 2002 with no significant history reported nausea and throbbing, bitemporal headaches at her 15 week visit. They were most bothersome in the evenings and upon waking. At her 21 week visit she reported persistent headaches with new onset dizziness. An echocardiogram and laboratory studies were normal. She was referred to neurology. At 23 weeks she had right and left beating nystagmus on exam and an unsteady gait. MRI revealed a 4 cm cystic lesion within the right cerebellum, mass effect on the fourth ventricle, and mild hydrocephalus with tonsillar and upward transtentorial herniation consistent with a hemangioblastoma. Neurosurgery planned urgent craniotomy and resection. RESULTS: The patient underwent uncomplicated surgery and pathology confirmed hemangioblastoma. Her postoperative course was uneventful with reassuring fetal status throughout admission. Her balance was markedly improved and neurologic exam was normal four weeks postoperatively. Testing for Von Hippel-Lindau syndrome was negative. The remainder of her pregnancy was uncomplicated. The team determined that she was a candidate for vaginal delivery. She underwent elective induction of labor at 39 weeks and progressed to vaginal delivery of a healthy female infant weighing 3370 g with Apgar scores of 9 and 9. She was discharged home with her infant on postpartum day one. CONCLUSION: Headaches, vomiting, and dizziness are common in pregnancy. Patients with severe, unrelenting symptoms require imaging and neurology consultation. Excellent outcomes are possible with a multidisciplinary approach involving obstetrics, maternal fetal medicine, neurology, and neurosurgery.